Deep scars are not a surface problem
A rolling scar is held down from underneath by fibrous tethering. Resurfacing the top of it — however many times — does not release what is pulling it down. The order of operations is the whole point.
Indented acne scars fall into three shapes, each treated differently. Rolling scars are tethered from below by fibrous bands and need subcision to release them before resurfacing helps. Boxcar scars have defined edges and respond to microneedling RF and fractional resurfacing. Icepick scars are narrow and deep and require precise, staged treatment. Enlarged pores are treated alongside but are a separate problem.
Three stages, in order
Scar treatment at DIESTA is structured as a sequence rather than a device choice, because performing the steps out of order wastes the sessions.
Release the base
Subcision — mechanically dividing the fibrous bands tethering a rolling scar to the tissue beneath. Without this, the scar is held down no matter what is done to its surface.
Regenerate and resurface
Microneedling radiofrequency or fractional resurfacing to stimulate collagen and rebuild the released area, filling the depression from below.
Refine pores and texture
Pore and surface work, once the structural problem underneath has been addressed.
This is why patients who have had 'lots of laser' elsewhere with limited improvement often have tethered rolling scars that were never released. The laser was working, on a problem that was not the limiting one.
Matching the scar shape to the approach
| Type | Character | Approach at DIESTA |
|---|---|---|
| Enlarged pores | Oil-type, or stretched and tear-shaped with age | Secret RF, Double Tite, fractional pico |
| Rolling scars | Broad, shallow, tethered from below | Subcision to release, then Secret RF or fractional resurfacing |
| Boxcar scars | Defined vertical edges | Secret RF, Alma Hybrid fractional |
| Icepick scars | Narrow and deep | Alma Hybrid, Secret RF — staged and precise |
| Red marks and pigment | Colour rather than texture | Moisturisation and sun protection first; these often fade without procedures |
Outcomes vary with skin type, scar depth and individual healing. Irritation, redness and pigment change are among the effects to be monitored. Scar treatment improves appearance; it does not restore skin to its pre-scarring state.
Devices at each location
| Device | What it does | Location |
|---|---|---|
| Subcision | Mechanical release of fibrous tethering beneath a scar | Gwanggyo |
| Secret RF | Microneedling radiofrequency | Gwanggyo |
| Alma Hybrid | Combined CO2, 1570nm fibre and ultrasound | Gwanggyo |
| Double Tite | Radiofrequency delivering skin boosters (Juvelook, Rejuran and others) simultaneously | Gwanggyo |
| Fractional pico | Picosecond fractional delivery | Gwanggyo |
| Pore Zero programme | Focused pore and texture programme | Cheonho |
| Multicell CO2 | Scarring, milia and defined lesions | Cheonho |
What improvement realistically means
Scar treatment improves appearance. It does not return skin to its pre-acne state, and any description suggesting otherwise is overselling. A realistic good outcome is a meaningful reduction in depth and shadow — scars that catch the light less harshly and read as texture rather than as damage.
This takes multiple sessions spaced over months, because each round of collagen remodelling needs time to complete before the next is useful. It is one of the least suitable categories for a compressed treatment schedule during a short trip: a single aggressive session produces more downtime and less improvement than the same energy spread across a proper course.
Redness and pigment left behind by past acne are a separate matter and frequently need no procedure at all — they fade with time and sun protection. Distinguishing colour from texture before treatment prevents spending sessions on something that was going to resolve anyway.
Frequently asked questions
Pore size can be visibly reduced, but it is managed rather than permanently changed — pore appearance is influenced by oil production, skin thickness and elasticity, all of which continue to change. Treatment improves how pores look by tightening the surrounding tissue and refining texture. What it does not do is permanently alter the anatomy, which is why maintenance matters and why claims of permanent pore removal should be treated sceptically.
The most common reason is that the scars are rolling scars, tethered from beneath by fibrous bands. Resurfacing the surface does not release what is pulling the scar down, so the depression persists regardless of how many sessions are performed. These scars need subcision to divide the tethering first; resurfacing afterwards then has something to work with. If you have had extensive laser treatment with disappointing results, this is the first thing worth assessing.
Multiple, spaced over months, and the number depends on scar type, depth and how your skin heals. The spacing is not a scheduling convenience — each round of collagen remodelling needs time to complete before the next session is useful, so compressing the course reduces the return on it. This makes scar treatment one of the poorer fits for a short trip; it is better begun as an ongoing plan.
Sometimes, and combining devices in one visit is common. But two treatments that both provoke significant inflammation in the same layer of skin, performed on the same day, can produce more downtime and a worse result than either alone. Which combinations work together and which compete is a clinical judgement made after examining your skin — not a menu to assemble in advance.
It depends heavily on which treatment. Microneedling RF and fractional resurfacing leave redness and swelling for days, and ablative fractional work can leave crusting that requires strict sun avoidance. Subcision causes bruising. None of these prevent normal activity, but they are visible — so if there is an event or a flight in the near calendar, plan the treatment around it rather than the other way around.
At-home microneedling and pore products operate at an intensity far below clinical treatment, which is what makes them safe to sell — and also what limits them. They can support skin quality; they do not release tethered scars or remodel dermal collagen meaningfully. The specific risk worth flagging is at-home needling on skin with active acne, which can spread inflammation and produce more scarring than it treats.